Provider First Line Business Practice Location Address:
6050 S FORT APACHE RD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-5614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-564-6712
Provider Business Practice Location Address Fax Number:
702-564-4838
Provider Enumeration Date:
10/09/2025